2020-06-10 PAG FinalPARTNERSHIP ADVISORY GROUP
JUNE 10, 2020 MEETING PAGE 1
ASSEMBLY
The Partnership Advisory Group met to hold a virtual meeting on Wednesday, June 10, 2020, at 5:30 p.m.
in Wilmington, North Carolina.
Members present via roll call: Co -Chair Barbara Biehner; Co -Chair Spence Broadhurst; Vice Co -Chair Bill
Cameron; Vice Co -Chair Dr. Joseph Pino; Members: Dr. Virginia Adams; Evelyn Bryant; Chris Coudriet; Cedric
Dickerson; Hannah Gage; John Gizdic; Dr. Sandra Hall; Tony McGhee; Dr. Michael Papagikos; Dr. Mary Rudyk; Dr.
Rob Shakar; Jason Thompson; and Meade Van Pelt.
Members absent: Robert Campbell; Brian Eckel; Jack Fuller; and David Williams.
Staff present: County Attorney Wanda Copley; Clerk to the Board Kymberleigh G. Crowell; Assistant County
Manager Tufanna Bradley; Chief Communications Officer Jessica Loeper; Chief Financial Officer Lisa Wurtzbacher;
Budget Officer Sheryl Kelly; Intergovernmental Affairs Coordinator Tim Buckland; New Hanover Regional Medical
Center (NHRMC) Director of Marketing and Public Relations Carolyn Fisher; NHRMC Chief Legal Officer Lynn Gordon;
NHRMC Chief Strategy Officer Kristy Hubard; NHRMC Executive Vice -President and Chief Financial Officer Ed 011ie;
Joseph Kahn, Shareholder with Hall Render and outside counsel for NHRMC; Carrie Joshi, Attorney with Hall Render
and outside counsel for NHRMC; Bryan Burgett, Director with Guidehouse; David Burik, Managing Director with
Guidehouse; Greg Van Alstyne, Senior Strategy Consultant with Guidehouse; Eb LeMaster, Managing Director with
Ponder & Company; and Robert Jaeger, Vice President with Ponder & Company.
Novant Health Representatives present via roll call: Carl Armato; Dr. Robert Barr; Tanya Blackmon; Dr.
Wesley Burks; John D. Cooper; Jesse Cureton; Frank Emory; Dr. Eric Eskioglu; Kevin Griffin; Fred Hargett; Joia
Johnson; Jeff Lindsay; Denise Mihal; Dr. Dawn Moose; Dr. Pam Oliver; Pat Phillips; Dr. David Priest; Dr. Elwood
Robinson; and Angela Yochem.
Co -Chair Broadhurst called the meeting to order and thanked everyone for participating in the virtual
format. This meeting is being held as a permissible virtual meeting with public access to open session components
in accordance with state law. As with all other meetings, the public can hear the open session portion of the
meetings, but is not participating in the meeting discussion, and there will be no questions from the public in this
forum.
NOVANT HEALTH PRESENTATION
Co -Chair Biehner welcomed representatives from Novant Health and thanked them for taking the time to
address members of the public as well as the PAG. Everyone is looking forward to hearing further about Novant
Health's proposal for a strategic partnership with NHRMC. PAG members were reminded they will be put on mute
and are to hold any questions until the closed session portion. She then asked Carl Armato, Novant Health President
and Chief Executive Officer, and his team to begin their presentation.
Carl Armato, Novant Health President and Chief Executive Officer, provided an overview of slides 1 - 16,
stating that he is looking forward to talking about how to expand the remarkable healthcare that is already in
Wilmington and the surrounding communities and how to do that through a potential partnership. He has been with
Novant Health for 22 years and has 33 years of healthcare experience. He wants everyone involved to learn about
Novant Health and hopefully get a feel for its culture. Although he is the CEO, he is focused on ensuring that every
patient has a remarkable experience, the highest quality, the superior quality, and safest environments that are
possible. He discussed six themes he wants everyone to think about while starting to talk about this potential
partnership. One is the fact that Novant Health brings a unique culture, and he has noticed that NHRMC also has a
very unique and wonderful culture. It will be heard how culture does matter in a relationship and in a partnership.
It is also recognized that NHRMC is a very strong health system with a very strong team. He wants it to be heard that
Novant Health is coming into this with a strength to strength partnership and relationship. The other items both
entities are focused on is remarkable healthcare, delivering excellence, delivering superior quality, and safety in
everything both do. It's fundamental to both organizations. In addition to that, physicians are the cornerstone of the
success of Novant Health, and it wants to ensure that physicians that are in the medical group and independent, can
see that Novant Health partners with physicians, so all physician voices are heard as to how resources are allocated,
and deliver the care that people need and deserve in every market served. Novant Health is bringing the best of both
worlds. It is bringing the best community hospital, but is also bringing UNC Healthcare and UNC School of Medicine
to continue the relationship that's been built with UNC for the last 40 years, not only to continue it but to expand
on it.
Mr. Armato introduced his board members: Pat Phillips, Chairman of the Novant Health Board of Trustees,
Dr. Robert Barr is Vice -Chairman of the Novant Health Board of Trustees and Chairman of the Novant Health Medical
Group Board of Trustees, Dr. Elwood Robinson, Chancellor of Winston Salem State University, Dr. Dawn Moose,
member of the Compensation and Leadership Committee for Novant Health Board of Trustees, and Joia Johnson,
Chief Administrative Officer, General Counsel and Corporate Secretary for Hanes Brands. He then introduced his
executive team noting that there are a number of senior executives that have a lifelong career of healthcare, but
there are also those who bring in many years of retail, banking, and other experiences that really has complemented
the success of Novant Health: Tonya Blackman, Executive Vice -President and Chief Diversity, Inclusion, and Equity
Officer, Dr. Pam Oliver, Executive Vice -President of the Novant Health Physician Network, Dr. David Priest, Senior
Vice -President and Chief Safety, Quality, and Epidemiology Officer, Dr. Wesley Burks, Dean of the UNC School of
Medicine, Vice -Chancellor for Medical Affairs and CEO of UNC Healthcare, Jesse Cureton, Executive Vice -President
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JUNE 10, 2020 MEETING PAGE 2
and Chief Consumer Officer, Frank Emory, Executive Vice -President and Chief Administrative Officer, Fred Hargett
Executive Vice -President and Chief Financial Officer, Angela Yochem, Executive Vice -President and Chief Digital and
Technology Officer, Dr. Eric Eskioglu, Executive Vice -President and Chief Medical Officer, and Jeff Lindsay, Executive
Vice -President and Chief Operating Officer.
Mr. Armato stated that slide 4 shows the foundation of what Novant Health stands for in its mission, vision
and values of the organization, its people, and the promises that it makes to communities. The 30,000 people at
Novant Health know how to bring each and every word to life. For example, Novant Health exists to improve the
health of communities one person at a time. They understand that it's each person, regardless of their ability to pay.
The vision of the Novant Health team is to deliver the most remarkable patient experience in every dimension, every
time. Consumers helped decide and determine what remarkable really should look like and they decided that safety
should be the number one superior quality in all that Novant Health delivers in healthcare and authentic personalized
relationships. They want to be partnered with Novant Health in their healthcare and make it easy for patients and
family members, not easy for Novant Health. Then there is affordability and how does Novant Health make sure that
it introduces price points that are affordable to all people. He is proud to say that Novant Health has deeply
embedded diversity and inclusion in its entire business operations and all of the strategic plan. They take these
values and bring them to life in every interaction, teamwork, personal excellence, courage, and compassion. They're
very important. He is proud that the mission, vision, and values come to life every day, in all of the clinics and
facilities. Novant Health's people are really important and it is an inclusive team of purpose driven, inspired, and
united by the passion to care for each other, the patients, and the communities. Investment is made in the people
in such ways as developing physician resiliency programs and nursing resiliency programs for the well-being of
Novant Health's people. An investment has also been made in leveraging internal female talent to ensure that all
women have the ability to soar inside of Novant Health. Finally, there is Novant Health's promise to its communities,
bringing world class care, world class technology, and world class physicians to when and where people need it.
Novant Health's goal is to make healthcare simple so that people can access care when and where they need it close
to home. Again, a bold vision of delivering remarkable care in every dimension, every time, with every patient. It's
an audacious goal which takes a lot of rigor, a lot of vigor, and operational excellence and he is proud to say that
Novant Health delivers this each and every day in all of the different operations within its 600 plus clinics, 15
hospitals, and all of the individualized markets that it operates in.
In review of slide 6, Mr. Armato provided an overview of Novant Health noting that the profits made are
reinvested back into communities, reinvested into its people, reinvested into the health system, and reinvested in
its facilities. The focus is on delivering superior quality across all of its markets. The organization is able to deliver
remarkable healthcare because it is physician -centric. Physicians are at the center and have a voice in everything
done inside the system from the local markets, all the way to the Novant Health corporate areas, and have a voice
in resource allocation. It has proven operating results across multiple markets and has very large markets from
Winston Salem to Charlotte to Northern Virginia. What Novant Health is hoping to see is the combination and
partnership with NHRMC, allowing for an equal market on the east coast. The dots on the map show the focused
growth and that it's about bringing healthcare closer to people, closer to where people live. These are 600 plus
clinics, with 60% of them being primary care. It's really about opening up access to care to all of those who need it.
Novant Health is financially strong, which allows it to ensure that the price points introduced in all of its markets are
affordable to all the individuals that are served.
In review of slide 7, Mr. Armato noted that in looking at the numbers he really wants it to be known that
each number represents people to him. It represents people who trust Novant Health to deliver remarkable care.
When he looks at the 54 million times a year that Novant Health team members wash their hands, he focuses on
that one person that they prevented from getting a hospital acquired infection. When he looks at the 5.5 million
encounters delivered inside of Novant Health, he looks at opening up access to the one person who hasn't had a
primary care visit and needs it. In addition to Novant Health being able to do that, it's because it has the physician
partners, those that are in the medical group, those that are independent, and have changed their delivery model
to ensure that access is opened up to all in the community. When Novant Health launched its electronic health
record, its physicians built it through the eyes of a patient, eyes of a consumer, and that's why it is one of the health
systems in the country that has over a million plus patients that interact with them on My Chart. Last year, team
members did close to 300,000 virtual visits. It's because the physicians have changed their delivery styles and went
to web based scheduling just to make it easy for patients to access care. While being a large system, Novant Health
really pays attention to the individual person and the remarkable care that people need and deserve.
Mr. Armato stated that safety and quality is a priority for Novant Health. Leapfrog has awarded nine Novant
hospitals with a grade of A and three hospitals with a grade of B. Novant Health is shooting for all A's, for top decile
performance, and he stressed the reason this can be done is by using predictive analytics, advanced analytics, and
getting data in the hands of its providers, physicians, nurses, and the administrative people to really change the
outcome for each and every patient. Novant Health is committed to delivering the remarkable and superior quality
that a person as an individual deserves to have.
Mr. Armato stated his job is really to ensure the culture of Novant Health is focused on ensuring its people
are cared for. Assuming there is a partnership, he wants to be clear that he takes this role very seriously about
ensuring the organization's people have all that they need and that their voices are heard. He regularly does webcast
meetings to make sure the team members, all 30,000, can have a conversation with him and the executive team.
Every Monday he does a blog to have a conversation with team members and open forums with team members that
get webcasted throughout the organization to hear the voices of all who might need them to make adjustments or
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changes inside of Novant Health. In addition to that, they have something called "no meeting Wednesday", where
he and the executive team do purposeful rounding to ensure that they can connect and hear what's really going on
at all of the facilities, whether it's in a clinic, in a hospital, or in a surgery center. He has a famous quote that they
started years ago: "We will become world class at caring for our people so that they can become world class and
caring for our patients". Press Ganey, a national survey organization, provides Novant Health with survey results
every quarter, and as of now Novant Health ranks in the 85th percentile of team member engagement. While not
satisfied at this percentile, it's top decile performance because Novant Health believes in investing in its people.
In review of slide 10, Mr. Armato reviewed examples showing Novant Health's experience of operating in
very large markets across different geographies and is used to resource allocation, working with local boards and
local decision making, and local management teams. In looking at NHRMC, he sees the potential of what can be done
together through a partnership. In looking at proforma, he sees an operation right out of the gate of having 67 clinics,
three hospitals, and over $1.6 billion in revenue. Novant Health sees a very unique opportunity with the investments
it wants to make in eastern North Carolina to continue to expand and grow that market so that it's on par with
Charlotte and Winston-Salem, and has a real voice in what's going on inside of Novant Health.
Mr. Armato then reviewed slides 11 and 12, which shows the financial strength of Novant Health. It is a
double A rated organization with $4.6 billion in net assets. Over the last few years it has had a 4.7% operating income
margin and a 12% operating cash flow margin. The debt has been reduced significantly, so there is very little debt.
Net assets are $4.6 billion with $3.2 billion in cash. All of this to say that Novant Health actually proposed a very
significant financial commitment to NHRMC, the local board, the management team, the community, and that it has
the resources to back that up.
In review of slide 13, Mr. Armato briefly highlighted Novant Health's multi -pronged approach to growing
and opening up access to healthcare in all of its communities. It's really based on what local communities need,
which comes from the local board, the local management team, and local physicians helping to identify what those
needs are. This is also done through just listening and understanding the needs of its communities. He then provided
brief examples of how Novant Health has done this in other places. There are a lot of unique opportunities for
strategic innovations, capital investments, and new partnerships that Novant Health thinks it could open up access
to and help many in the Wilmington area and the surrounding communities. It has some very innovative ways of
approaching growth and the team looks forward to working with the local board and the local management team to
open up access to healthcare. Novant Health has been investing in communities and partnering with its communities
for a number of years. An example of this is the Community Care Clinic that was created in partnership with Winston-
Salem State University, to really meet the unmet healthcare needs of that community for people that couldn't access
primary care. In Charlotte, Novant Health has a mobile clinic where over 7,000 children have received care, many of
them vaccinations, that have allowed them to actually now go to and actually participate in public schools where
they might not have otherwise been allowed. Another example is that Michael Jordan has just committed $7 million
so that Novant Health could build two Michael Jordan family clinics to take care of those in need. Mr. Jordan did this
because as he said in his statement, he believed in Novant Health's mission, its vision, its values, and purpose of
ensuring that all people have remarkable care. Novant Health will be looking for other opportunities to ensure that
it is meeting the unmet healthcare needs in new communities. He then reviewed slide 15 noting that in 2019 Novant
Health provided $993 million of community benefit. Novant Health is focused on closing the health disparity gap, if
not eliminating health disparities, with chronic conditions, addressing maternal and infant health gaps that it really
needed to address in its communities, as well as looking at diabetes prevention and screenings. Novant Health has
opened its doors so that all who need healthcare have access to the remarkable care it is known for. Its financial
assistance policy is one of the most remarkable in healthcare in that anyone at or below 300% of the federal poverty
level does not get a bill from Novant Health. Last year, the organization provided $153 million in charity care to help
people receive the care they need and deserve.
In review of slide 16, Mr. Armato stated that another important issue that's going on across all communities
is the need for behavioral health services and mental healthcare. Novant Health takes mental health care as serious
as cancer care and cardiology care. It has worked with all of its primary care practices to integrate an approach to
dealing with behavioral health services and mental health services through telehealth. Predictive analytics and
analytic technology have been used to be able to predict and reduce the number of suicides across its footprint.
Novant Health has also partnered with others who are already addressing mental health and behavioral health
services across its footprint, like HopeWay. Novant Health made a financial investment in that organization to come
to its community. The electronic health record system was also integrated to ensure that regardless of where
patients show up, whether they're in the emergency room or whether they're at HopeWay or other facilities, the
care they need and deserve can be followed as well as any medications that they're on. Novant Health also believes
this is a very serious component of health equity and it will be addressing that.
Tanya Blackmon, Novant Health Executive Vice -President and Chief Diversity, Inclusion, and Equity Officer
stated when she thinks about what's been happening in our country, COVID-19 has really occupied or dominated
our news, our organizations, as well as our personal lives. This past week we've had a new element of chaos in our
lives with the death of George Floyd and the subsequent protests that have occurred. That is really not a new
element, it's really a series of events that have been happening and the reality of our nation at this time. It's a racial
divide and a socio-economic divide that harms our communities, and the people all around us. This is why she is
excited to discuss what Novant Health has been doing through actively embedding diversity and inclusion for a
number of years. In 2016, Mr. Armato signed a pledge with the American Hospital Association to eliminate
healthcare disparities. That is why diversity, inclusion, and equity together is a real priority for Novant Health. In
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looking at slide 18, you will see that diversity and inclusion is interwoven into everything that Novant Health does in
its mission, vision, and values. From the very beginning, Novant Health knew that this work was not about adding a
program, but it was about taking an approach that really helped the organization to understand people, its patients,
team members, and community. The approach is a culture change strategy to have diversity, inclusion, and equity
as a deep part of the organization. This is really a business strategy and a shared driver with three major aspects.
One is to become a healthcare provider of choice for all people, second is to be the employer of choice where Novant
Health reflects the communities that its serves and where all of its workforce reflects the communities that it serves,
and third is to be a leader in health equity. A key component in creating an inclusive environment is to ensure that
you have definitions. Novant Health took the time to define diversity and inclusion because the team knew it would
be a critical part of the organization's success. Diversity for Novant Health is that there are "...the similarities and
differences of people found in our workplace and in our marketplace." Ms. Blackmon noted on slide 19 the words
visible and less visible explaining that if you don't think about or pay attention to the less visible characteristics of
people then you don't see the whole person, so it's really important to do that. At Novant Health, diversity wasn't
enough. The team said that they knew that inclusion really went with diversity and that they were equally as
important so time was taken to define it. Inclusion for Novant Health is intentionally engaging human differences
and seeing those differences as strengths in both their team members and patients. When you have an inclusive
environment, you're giving people a voice. Novant Health wanted to create a space for people to feel welcomed and
to feel like they could thrive and move on health.
In review of slide 20, Ms. Blackmon explained the next steps taken in the process was to really understand
how and what Novant Health's reality was, and to hear the words and the voices of its team members and
communities. The desire was to make sure Novant Health could do it accurately, which is really important to
understand the issues, the needs of its patients, team members, and communities. She spent several months
speaking with almost 700 people to help Novant Health build its foundation. The vision, strategy, and how it was
going to embed and measure its success in the diversity and inclusion space emerged through eight themes as shown
on slide 20.
In regard to health equity, it is important to understand what is meant, to know that we're talking about
the issues and needs of people and what we're trying to achieve is not equality, but really equity. When you look at
the pictures on slide 21, there is a difference. The top one is about equality, everyone gets a bike. In the second
picture, everyone gets a bike that fits them. That is really what Novant Health's goal is, getting a bike that fits the
person. They don't want people just to have a bike, they want people to be able to ride a bike. For Novant Health it
is not about programs, it's about people and giving them the tools and information that they need to have healthy
outcomes. She does understand challenges and that the challenge in healthcare is to understand the needs and
customize care for what patients need and want. When she thinks about the missions of both organizations,
NHRMC's involves outstanding health for its communities and Novant Health's is to improve the health of our
communities, one person at a time. We must customize care for our patients if we're going to achieve our mission
to improve health outcomes for our patients. Novant Health defined health equity as the attainment of the highest
level of health for all people, and it has two critical components. The first one is about health disparities, and it's the
burden of disease in one particular population, for example, in the African-American population, the Latino
population, and the Native American population, there's a higher prevalence of diabetes. Novant Health is targeting
how does it reduce that burden and is working to do that. The next category is healthcare disparities, which is about
coverage and access to quality care. One of the things that Novant Health has done and is a great example is that
during this COVID-19 pandemic, it was the first in its communities to open respiratory centers that did testing for
lower income communities. As a result, its testing rates for Latinos and African-Americans is higher than the overall
testing rate in North Carolina.
It's one thing to have a vision but it's quite another to make it a reality and Novant Health really has a
strategic commitment to do that. As shown on slide 23, its process is pretty simple as shown on the right. It's that
Novant Health works hard to identify the gaps, develop strategies, and then implement those throughout its system.
On the left, there are some guiding principles and it's always about patient safety and quality, community
integration, and equitable access to care. It includes looking at the data in a very special way, through an analysis
called Real Gaps that looks at race, ethnicity, age, language, gender, pay or source, and sexual orientation. When
that is done, it allows the teams to see the gaps, close the gaps, and make improvements in care.
Ms. Blackmon stated that slide 24 shows that Novant Health really believes in the community and how it
has deepened its connections to the community and closed gaps in care and services. Novant Health does not
reinvent the wheel, what it does is partner with great organizations who are doing wonderful work to address social
determinants of health in its communities and for its patients. For Novant Health, diversity, inclusion, and equity is
really very holistic in how it does things, which extends to engaging its communities. Slide 25 is an overview of how
Novant Health has partnered with organizations or businesses owned by women and minorities, to really energize
economic development for them. It started this process with supplier diversity in 2006 and at the end of 2019, it
spent $1 billion with its organizations that are businesses owned by women and minorities. Also included were
businesses owned by veterans and persons who are disabled, so it's a real way for Novant Health to connect with its
communities and purchase goods and services.
Ms. Blackmon stated that in the beginning she mentioned that Novant Health wants to be a leader in health
and one of its goals is to be a leader in health equity and that is what it has been doing. As shown on slide 26, Novant
Health has been able to close the gaps in looking at pneumonia patients. In looking at its data to see the gaps, it was
also found that there was a large gap between blacks and whites in the readmission rates. It was actually a four
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percentage point gap. What people don't often understand is that when you focus on the gap you improve care for
everyone. Novant Health was able to close the gap for blacks and whites, reducing the readmission rate for both. It
was recognized for by the Centers for Medicare and Medicaid for closing the gap in the pneumonia population and
was the first to receive the award for it. Work was also done with its moms in the community. At the Novant Health
Brunswick Medical Center, team members, as well as the community, identified that there was a gap with patients
who are moms, who were underserved, and didn't have the resources and tools to provide care for their baby after
delivery or to have a healthy pregnancy. In working together, they were able to get resources for their moms and
babies, and their needs were met.
Dr. Elwood Robinson, Winston-Salem State University Chancellor and Novant Health Board of Trustees
members stated that the partnership with Novant Health, since it came to Winston-Salem State University (WSSU)
six years ago, has been great. It is because of that partnership that WSSU continues to be one of the leading
universities in the UNC system in terms of healthcare and third largest producer of nurses because of the relationship
with Novant Health. Because of Novant Health, WSSU is the only historically black college and university (HBCU) in
the country that has two mobile health clinics to be able to provide services for hard to reach citizens in Winston-
Salem. He was at North Carolina Central University for 28 years, and that community did not have that kind of
relationship with Duke University. He is also a resident of Ivanhoe, NC which is right down the street from
Wilmington, so he knows Wilmington, he has worked in Wilmington, and in fact, he thinks he worked on part of the
New Hanover hospital a long time ago when he worked for a plumbing company. He was able to share with the
Novant Health team that there are so many people they could call on such as Hannah Gage and Dr. Virginia Adams
if they want to know about Winston-Salem. Dr. Robinson considers Dr. Papagikos a saint for his help with his aunt
who was in Wilmington and for speaking with him directly about her care. These are the kind of people that he
knows are in New Hanover County and Wilmington. That is what he told the Novant Health board as well as this
being a special group of people.
Dr. Pam Oliver, Novant Health Executive Vice -President and President of the Novant Health Physician
Network, reviewed slides 29 through 37, stating her heart is in eastern North Carolina as she was born and raised in
Rocky Mount, North Carolina. That is where she understood and came to learn about the importance and power of
community. It was her father battling leukemia that led her down the path to medicine. It was her roots in that
community that led her to a joint degree in Public Health and leads her to her passion, which is taking care of our
entire community. She is an obstetrics/gynecologist physician in Winston-Salem and is proud to lead the Novant
Health Physician Network, and is a product of what has been said about physicians being at the cornerstone of all
that is done at Novant Health. From the time that she was a leader in the practice, through leadership opportunities
at different levels, and now leading at the executive team level, Novant Health continues to develop, involve, and
engage its physicians to make sure that their voices and opinions are at every level in every decision that is made.
Novant Health's success in providing patient centered personalized high quality care is definitely a result of
this voice and leadership of the physicians. Whether employed or independent, Novant Health has physicians at the
table, developing strategies, leading through growth, innovation, and community outreach. The physicians give so
much of themselves and in caring for patients and Novant Health recognizes that nationally there are issues whether
it's burnout, or just a difficult time to be in medicine, that it is committed to them and their well-being. One of
Novant Health's physicians developed a resiliency program, leads it, and now goes across the country sharing it, and
has been nationally recognized for the work that he is doing to help all of them extend their careers and get back to
what they got into medicine for. Novant Health is very proud to support him because of what it gets back from its
physicians and advanced practice nurses and physician assistants (APPS). This has also been extended to other areas
of the company to make sure all are healthy as they try to improve the health of their communities. Other programs
have been launched related to onboarding providers, making sure that they are successful, and developing their
leadership potential at all levels. One thing Dr. Oliver is really proud to see is that NHRMC, like Novant Health, has a
strong empowered medical group, but also has partnerships with many independent physicians in the community
caring for the community. 60% of Novant Health's medical staff at its hospitals are independent, but are incredibly
important to its ability to deliver the care that is given and that the patients deserve. There are no one size fits all
when it comes to partnering with physicians. As shown on slide 32, Novant Health has developed a menu of options
for its partners, whether it's just access to facilitating its electronic medical record so coordination of patient care is
better, all the way through partnering with a clinically integrated network and payer products where it can deliver
the highest quality care at the lowest cost. Novant Health's network for Medicare Shared Savings is in the seventh
percentile in the nation for lowest cost, and fourth in the entire nation for quality and it is very proud of its teams
coming together for that.
Growth in Novant Health's employee medical group has been foundational to the organic growth
mentioned earlier and the ability to deliver on its mission, which is to improve the health of communities one person
at a time. So while it has one of the largest medical groups in the country by physical locations, it is not about being
big. It's been very intentional growth, supporting access points in all parts of its community to get care closer to its
patients, including traditionally underserved communities. Physicians are recruited who Novant Health knows are
culturally aligned with it mission and they, in turn, recruit their friends and colleagues. This has been a big impetus
for growth over the years, and the team has expanded to include even more advanced practice providers who
surround patients to provide the best care from a team based approach, and also has led Novant Health to the best
outcomes. In fact, 10% of its providers, APPS and physicians in its medical group, rank in the top one percent
nationwide when it comes to human experience or patient experience.
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One reason that Novant Health cares deeply about these things, and the data is clear, is because when
patients have a positive experience with their provider, they're more likely to follow instructions, follow up when
they're asked to, and feel comfortable to ask the questions that will keep them healthy. Novant Health is committed
to that experience but also to the highest quality and the safest care, and it's not just because that's what you expect
and you should expect. It's because that's what you deserve. It is how the best results are achieved to improve the
health of the community. An investment has been made in data, analytics, and processes to make sure that Novant
Health's physicians and APPS have access to it transparently so that it empowers them to make the right decisions,
to get low infection rates, to decrease the chance of a patient actually being readmitted when they leave the
hospitals. As reflected on slide 35, Novant Health's success when it comes to high quality and safe care has been
acknowledged by numerous agencies, awards, and high ratings across the board. While each award is definitely
validation and has developed a sense of pride for the team, it is not about the award. It's about saving lives, it's
about getting patients well and keeping them healthy. As to the Magnet designation, it's not about the plaque
received, it's about the commitment that Novant Health is making to its nursing teams in their development and
their retention. As such, Novant Health has been able to achieve that high quality care and reduce readmissions.
Dr. Oliver stated that in review of slide 36, she understands that NHRMC has a long history of commitment
to stroke care and having a joint commission certified comprehensive stroke center. On this front, Novant Health is
one of only four health systems in the country with two joint commission certified comprehensive stroke centers.
One thing that is monitored closely with stroke care is how quickly the team acts to treat a patient once it is
confirmed that they actually are having a stroke. Novant Health already had industry leading times with regards to
this, but it did not stop there. It pivoted at the system level to develop transformational research capabilities and
started to invest more in artificial intelligence and investing in a technology solution called Viz.ai, where doctors
receive a notification and can identify a stroke while a patient is still in the CT scanner. This technology has shaved
10 minutes off of Novant Health's already industry leading times and that means that a patient saves 19 million brain
cells in that 10 minutes that is saved. That makes a difference in patients being able to walk out of the hospitals
without major deficits and receiving a higher quality of care, and that is more important than anything else.
Novant Health is the first in the country to receive an FAA waiver to fly drones long distances over populated
areas. It is currently experimenting with drone based distribution for PPE and clinical supplies. As shown on slide 37,
this particular example although it captures the public imagination, it is really just one of dozens of ongoing
innovations that Novant Health is pursuing. Dr. Oliver concluded her comments stating the potential collaboration
between Novant Health, UNC, and NHRMC truly is the potential for historic collaboration, because she knows that
only Novant Health with UNC can truly provide the comprehensive community based care and add to what NHRMC
is already doing for the people of southeastern North Carolina.
Dr. David Priest, Novant Health Senior Vice -President of Safety, Quality and Epidemiology, reviewed slides
38-44, stating that the drone is one of the products of the Novant Health Institute of Innovation and Artificial
Intelligence. Another product is Novant Health's clinical data and predictive analytic capabilities. Novant Health
partners with numerous companies and pursues artificial intelligence and machine learning applications that assist
in the quadruple aim of better outcomes, lower costs, improve patient experience, and improve clinician experience.
Novant Health has an amazing clinical data team. They can visualize the data effectively and get it into the hands of
people who need it most, which is the providers, so they can care for their patients. Having the ability to be nimble
from a data standpoint, allows for the ability to quickly respond to whatever clinical needs providers and patients
have. Dr. Priest then reviewed examples of Novant Health's data tools used in response to COVID-19. The Microsoft
Teams platform is utilized and in practice there are interactive dashboards that allows the teams to click through
data down to the patient level. The dashboards update on an hourly basis and give the teams access via their
computers and smartphones so they can see all that data in real time. When COVID-19 hit, the teams already had a
data architecture in place to immediately have the information needed to respond. Novant Health has done over
72,000 COVID-19 tests as an organization. It was felt at the beginning of the pandemic testing should be done
aggressively in their communities and that's what was done. 12 testing centers were setup at multiple locations in
their communities, particularly in underserved areas, and also included mobile testing units. With a data tool like
this, the number of positive tests can be tracked at all of the locations in real time, which allows the teams to respond
to their communities and hospitals. They can also track information by county so that Novant Health can partner
with its public health departments and provide those departments with logistical support and also testing supplies.
Having these tools on hand also allowed for the ability to enroll patients in COVID-19 clinical trials. Novant Health
had three different clinical trials up and running and one of those was up and running in four days. It was the second
in the country in enrollment in one of those trials using a drug called leronlimab, so its clinical trials were often
beyond most academic medical centers. In addition to having clinical data in real time, Novant Health also has its
clinical care in real time and the supplies needed to care for patients. The sourcing team did a remarkable job in
keeping Novant Health stocked with all the needed PPE, never having a shortage. In real time, different markets and
hospitals can click on their dashboard and see what supplies they have and where those supplies are. Another
favorite tool of Dr. Priest's is being able to look at the database to see the characteristics of patients with COVID-19
as well. The teams can see what medical issues patients have, how the pandemic is affecting individuals based on
gender, age, location, race, and ethnicity. Novant Health knows COVID-19 is disproportionately affecting members
of the Latino and African-American populations, and this dashboard allows the teams to understand those
differences and customize the care for those patients. It is another example of how diversity and inclusion are
embedded in everything Novant Health does and that lens is applied to ensure that all the patients get equitable
care.
PARTNERSHIP ADVISORY GROUP
JUNE 10, 2020 MEETING PAGE 7
In review of slide 44, Dr. Priest stated in order for the facilities to move towards reopening elective services,
there was a need to ensure the patients were safe as well as the team members. The dashboard shown on slide 44
is the pre -procedural testing dashboard and it is utilized to track procedures, including elective surgeries, labor and
delivery, other procedures, and gives additional information on prevalence to keep the community safe. That's very
important for the peace of mind of Novant Health's surgeons and patients. Many of the patients delayed their care
because of COVID-19 and they're concerned about the safety of the hospitals, so this allows for the ability to provide
them that reassurance and get them back into the care they really need. Novant Health has a lot to offer as it pertains
to clinical data both in its visualization and ease of use, and giving meaningful insight to providers and leaders.
Dr. Wesley Burks, Dean of UNC School of Medicine, Vice Chancellor for Medical Affairs, and CEO of UNC
Healthcare, in review of slides 45 through 49, expressed appreciation for the opportunity to speak with the group.
He is really excited about the partnership and everyone's ability together, to serve the people of southeastern North
Carolina in an educational and clinical partnership. As announced recently, Novant Health, UNC Health, and UNC
School of Medicine are working together to develop this partnership to enhance medical and overall health
education and subspecialty clinical services in the region. UNC Health and UNC School of Medicine are different
entities, but are closely aligned in a common mission to truly serve the people of North Carolina. The teams at Novant
and UNC started working together in late April and quickly developed a good relationship with each other and it is
highlighted by a common culture across the organizations and a common commitment to this region. This common
culture that they share, and after working with colleagues at NHRMC for several years, Dr. Burks stated he truly
believes in the culture that there is a commitment to the people where we live and colleagues with whom we work.
He also believes a shared and common culture is the most important part of the decision for the future. He then
provided an overview about who the organizations are in this partnership, what they want to do, how they are going
to do it, and why this partnership, the medical education, and clinical components are important.
Part of the mission of the UNC School of Medicine and the healthcare system is to improve the health and
well-being of the people in North Carolina, and those whom they serve through patient care, education, and
research, as well as their commitment to service to the community. In looking at slide 46, the U.S. News and World
Report ranked UNC School of Medicine ranked number one for primary care training and it has received this ranking
for the last several years. Its schools of pharmacy, public health, and nursing are rated first, second, and third in the
country. From a research standpoint, UNC -Chapel Hill is ranked fifth in federal research dollars expended, more than
any other institution or university in North Carolina. In the last decade it has received two Nobel prizes. The science
breakthrough of the year was for work done on HIV. As far as places to work, it's a really nice place to work. People
purposefully come to work at UNC Health and UNC School of Medicine and they are thankful for that.
The vision is a really transformative partnership between Novant Health, UNC Health, UNC School of
Medicine, and NHRMC. They would like to train more medical students and other health professionals in NHRMC by
first expanding the UNC School of Medicine branch campus. There has been a branch campus with NHRMC
colleagues for the last several years and the desire is to significantly expand it. They also want to expand the
opportunities for training as a resident and as a fellow where you're more likely to have people stay long term in the
area as well as develop a UNC Health Sciences Campus with other schools such as pharmacy, dental, etc. that can
do their training locally, more likely stay in the area, and they are ready to do this as soon as the local community
feels it's the right time. They also want to expand the opportunity to enroll in clinical trials closer to home. Someone
should not be penalized personally in their care because they live too far away from enrolling in a really important
clinical trial. UNC, along with Novant Health, can help do that better. There is hope to create a pipeline for future
healthcare professionals in the health sciences that have been discussed. There is also a desire to enhance the
relationship with NHRMC to provide ongoing high quality complex care for children by partnering with providers in
the community. This will be done through local partnerships and an increased investment from all of us in the
regional clinical workforce. Dr. Burks provided an overview of what could be accomplished through this partnership
for this community and the region NHRMC serves.
As to why this partnership is important, Dr. Burks stated it is felt it will enhance the care and the quality of
life of the people that are in collaboration with NHRMC. The partnership with Novant, UNC Health, UNC School of
Medicine, and NHRMC can improve the health of the region by improving access to high quality care close to home.
It will help grow the pipeline of high quality health professionals that enhances care now, it also will help them live
in the area and enhance care long term and it will create new jobs now in the future by being an attractive option
for trainees who, once they complete training, are much more likely to stay for a lifetime. It is also felt it truly will
enhance the profiles of the region by making it a destination for healthcare and education that will have long term
impact. The organizations are within a few days of having a signed document that does the things that will help in
this partnership and there is a commitment to doing that.
Mr. Armato, in review of slides 50-55, stated he just wanted to quickly highlight that NHRMC and Novant
Health have a shared mission, vision, and values. Novant Health knows NHRMC has a remarkable culture and it wants
to first start and then build a partnership on two organizations that are strong and that have very strong cultures.
Novant Health wants to allow NHRMC and the surrounding communities to become a flagship at Novant Health, to
be a partner with Novant Health, not a part of something, because it is believed this is a strength to strength
partnership. The cultures are aligned and both want to invest in their people. The best of both worlds is being
brought forward with Novant Health and UNC Healthcare. Also, Novant Health depends on local governance. It
wants the local board and the local management team to continue to operate as they are today with fiduciary
responsibility. Novant Health has made a remarkable commitment of capital, almost $3 billion to continue the
economic development on the eastern coast.
PARTNERSHIP ADVISORY GROUP
JUNE 10, 2020 MEETING PAGE 8
Novant Health wants to create an integrated regional network that actually takes the assets of Novant
Health that already exist on the coast and put it under the operating control of the local management team, John
Gizdic and his team, who are highly thought of. Novant Health also wants the local board and the local physicians to
work with it in creating new service lines, new approaches to expand care, to go after a superior quality and
remarkable care for all. Novant Health also wants to ensure that it brings the corporate responsibilities and
capabilities it has, but really to allow NHRMC to take the strategic plan that is developed and thrive.
Mr. Armato stated that slide 54 shows the objectives that came out in the original request for proposal and
that Novant Health believes it has delivered on each and every one of them: the access to care, value of care,
affordability, achieving health equity, engaging staff, partnering with providers, driving superior quality, growing the
scope and level of care with UNC and others, and ensuring financial security. Novant Health wants to strategically
position NHRMC and will ensure the local governance continues to govern and has authority over what's going on in
the marketplace, including hearing from physicians.
Mr. Armato concluded the presentation stating the fact that culture is everything and it is felt the two
cultures are aligned, it is absolutely believed that this is a strength to strength partnership, and Novant Health
respects and will learn from NHRMC. In addition to sharing best practices, Novant Health believes that NHRMC has
always focused on superior quality and remarkable care, NHRMC calls it excellent care, Novant Health calls it the
remarkable patient experience, and it will continue. Physicians have been the cornerstone of both organizations'
successes, and Novant Health wants to ensure all physicians, whether in the medical group or independent, have a
voice in all the resources and care that it can provide and the care that is decided by the community it needs because
they know best. He also feels Novant Health is bringing the best of both worlds, by bringing one of the largest not-
for-profit healthcare systems in the country that is financially strong, along with UNC Healthcare and UNC School of
Medicine, to really enhance and grow the economic development of Wilmington. It is because of these
characteristics that Novant Health believes it is the best strategic fit, the best partner, and it is ready to stand behind
its capital commitment and invest in NHRMC. He thanked the PAG for the opportunity for his team to make the
presentation.
Co -Chair Broadhurst expressed appreciation for the comprehensive presentation and the public for joining
the meeting and for being involved and engaged in this important process for our community.
CLOSED SESSION
Co -Chair Broadhurst announced that the meeting would move into closed session for confidential
discussion and review of confidential information, pursuant to North Carolina General Statute (NCGS) 143-
318.11(x)(1), NCGS 143-318.11(a)(3), and NCGS 131E-97.3. These protect competitive healthcare activities and
attorney-client matters. He asked for a motion to move into Closed Session.
Motion: Vice Co -Chair Pino MOVED, SECONDED by Member Rudyk to enter into a closed session pursuant to NCGS
143-318.11(a)(1), NCGS 143-318.11(a)(3), and NCGS 131E-97.3. These protect competitive healthcare activities and
attorney-client matters. He asked for a motion to move into Closed Session. Upon vote the MOTION CARRIED
UNANIMOUSLY.
Co -Chair Broadhurst excused the public participants and convened to Closed Session at 6:48 p.m.
CONVENE TO OPEN SESSION AND ADJOURNMENT
Co -Chair Broadhurst called the meeting back to order at 7:38 p.m. and thanked the members for their
discussion and work during the closed session and expressed appreciation to public who remained on the line during
that time. There being no further business, he adjourned the meeting at 7:39 p.m.
Respectfully submitted,
/Kymberleigh G. Crowell/
Kymberleigh G. Crowell
Clerk to the Board
Please note the above minutes are not a verbatim record of the Partnership Advisory Group meeting. Meeting
materials associated with this meeting are included as attachments to these minutes for reference.
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